Rogers Tova, Marino Maria, Dusza Stephen W, Bajaj Shirin, Marchetti Michael A, Marghoob Ashfaq
Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Dermatol Pract Concept. 2017 Apr 30;7(2):39-46. doi: 10.5826/dpc.0702a09. eCollection 2017 Apr.
Dermoscopic triage algorithms have been shown to improve beginners' abilities for identifying pigmented skin lesions requiring biopsy.
To estimate the diagnostic accuracy of the Triage Amalgamated Dermoscopic Algorithm (TADA) for pigmented and nonpigmented skin cancers. Secondarily, to compare TADAs performance to those of existing triage algorithms for the identification of pigmented skin cancers.
Cross-sectional, observational, reader study that took place at a beginner and intermediate level dermoscopy course.
Two hundred medical professionals of various specialties attended the course and 120 voluntarily joined the study (60% participation rate).
After receiving basic dermoscopy training, participants evaluated 50 polarized, dermoscopic images of pigmented (22 benign, 18 malignant) and nonpigmented (1 benign, 9 malignant) skin lesions using TADA. Pigmented lesions were also evaluated using the Three-Point Checklist and AC Rule. With TADA, participants first determined if a lesion was an unequivocal angioma, dermatofibroma, or seborrheic keratosis, which would exclude it from further evaluation. All other lesions were assessed for architectural disorder, starburst pattern, blue-black or gray color, shiny white structures, negative network, ulcer/erosion, or vessels. Any one feature indicated suspicion for malignancy.
Most participants were dermatologists (n=64, 53.3%) or primary care physicians (n=41, 34.2%), and many lacked previous dermoscopy training (n=52, 43.3%). TADA's sensitivity and specificity for all skin cancers was 94.6% (95% CI=93.4-95.7%) and 72.5% (95% CI=70.1-74.7%), respectively. For pigmented skin cancers, the sensitivity and specificity were 94.0% (95% CI=92.9-95.0%) and 75.5% (95% CI=73.8-77.2%). This compared to 71.9% (95%CI=69.8-73.9%) and 81.4% (95%CI=79.7-83.0%) for the Three-Point Checklist and 88.6% (95%CI=87.1-89.9%) and 78.7% (95%CI=76.9-80.3%) for the AC Rule.
These results suggest that TADA compares favorably to existing triage algorithms and might be a useful triage tool with high sensitivity and specificity for pigmented and nonpigmented skin cancers. Further studies are needed to validate these preliminary observations.
皮肤镜分诊算法已被证明可提高初学者识别需要活检的色素性皮肤病变的能力。
评估联合皮肤镜分诊算法（TADA）对色素性和非色素性皮肤癌的诊断准确性。其次，将TADA的性能与现有分诊算法在识别色素性皮肤癌方面的性能进行比较。
在初级和中级皮肤镜课程中进行的横断面、观察性读者研究。
200名不同专业的医学专业人员参加了该课程，120人自愿参与研究（参与率60%）。
在接受基础皮肤镜培训后，参与者使用TADA评估50张色素性（22例良性，18例恶性）和非色素性（1例良性，9例恶性）皮肤病变的偏振皮肤镜图像。色素性病变也使用三点检查表和AC规则进行评估。使用TADA时，参与者首先确定病变是否为明确的血管瘤、皮肤纤维瘤或脂溢性角化病，若为上述情况则无需进一步评估。所有其他病变均评估其结构紊乱、星芒状模式、蓝黑色或灰色、亮白色结构、无网络、溃疡/糜烂或血管情况。任何一项特征提示恶性可疑。
大多数参与者为皮肤科医生（n = 64，53.3%）或初级保健医生（n = 41，34.2%），许多人此前缺乏皮肤镜培训（n = 52，43.3%）。TADA对所有皮肤癌的敏感性和特异性分别为94.6%（95%CI = 93.4 - 95.7%）和72.5%（95%CI = 70.1 - 74.7%）。对于色素性皮肤癌，敏感性和特异性分别为94.0%（95%CI = 92.9 - 95.0%）和75.5%（95%CI = 73.8 - 77.2%）。相比之下，三点检查表的敏感性和特异性分别为71.9%（95%CI = 69.8 - 73.9%）和81.4%（95%CI = 79.7 - 83.0%），AC规则的敏感性和特异性分别为88.6%（95%CI = 87.1 - 89.9%）和78.7%（95%CI = 76.9 - 80.3%）。
这些结果表明，TADA与现有分诊算法相比具有优势，可能是一种对色素性和非色素性皮肤癌具有高敏感性和特异性的有用分诊工具。需要进一步研究来验证这些初步观察结果。
